Provider Demographics
NPI:1922294800
Name:ARMANDO SIQUEIROS MD INC
Entity Type:Organization
Organization Name:ARMANDO SIQUEIROS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIQUEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-543-8310
Mailing Address - Street 1:1241 JOHNSON AVE
Mailing Address - Street 2:PMB 329
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3306
Mailing Address - Country:US
Mailing Address - Phone:805-543-8310
Mailing Address - Fax:805-543-3754
Practice Address - Street 1:148 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-543-8310
Practice Address - Fax:805-543-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1994832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15105Medicare PIN